CMS/EIP Fiscal Report Center: 10
Services beginning 10/01/2009 ending 12/31/2009 Date of Report:02/16/2010 Page: 1
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 16 17.00 180.54 10.62
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.00 16.30 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 16 18.00 158.94 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 17 19.00 197.22 10.38
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 17 19.00 414.01 21.79
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 14 16.00 452.48 28.28
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.00 46.80 46.80
AUDE-V5090-DISPENSING FEE PER HEARING AID 2 6.00 478.40 79.73
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 18 20.00 921.50 46.08
PSTH-97001-EVAL BY LICENSED PT, INITIAL 6 6.00 291.00 48.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 20 22.00 1018.50 46.30
Subtotal (Total Children Is Unduplicated) 59 145.00 4175.69 28.80
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 4 27.00 2223.26 82.34
AUD-HA_FUP-AUDIOLOGY SERVICES 2 2.00 100.00 50.00
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 107 108.75 5437.50 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 2 0.50 12.50 25.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 4 4.00 200.00 50.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 14 12.00 600.00 50.00
CONOP-CONOP-CONSULT, OT, PHONE 3 0.75 18.75 25.00
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 0.50 25.00 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 19 18.50 925.00 50.00
CONSP-CONSP-CONSULT, SLP, PHONE 6 3.00 75.00 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 28 113.00 2825.00 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 3 15.00 750.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 259 2786.00 139300.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 257 1251.00 81884.70 65.46
OCCT-97530HM-OT SESSION BY OT ASST 16 46.00 2498.16 54.31
PHY-97110-PT SESSION BY LICENSED PT 393 1557.50 101500.50 65.17
PHY-97110HM-PT SESSION BY PT ASST 1 0.50 27.16 54.32
SENS-HA_EIP-ONE UNIT UP TO $500 PER AID 2 4.00 2000.00 500.00
SENS-V5264-EARMOLD 2 4.00 74.88 18.72
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 550 2397.75 160914.97 67.11
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 20 53.00 2851.80 53.81
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 500 105970 52985.00 0.50
Subtotal (Total Children Is Unduplicated) 926 114375 557229.18 4.87
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Total 114519.75 561404.87 4.90
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Number of Children (Unduplicated) With at Least One Service 936
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Center 10
Flag Claims Units Chgs Paid
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R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 3852 110367.00 303370.27 303370.27
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
2135 4152.75 258034.60 0.00
Other 0 0.00 0.00 0.00
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Total 5987 114519.75 561404.87 303370.27